Abstract
We report herein on a 24-year-old male who complained of vertigo and tinnitus caused by cerebellar hemorrhage from an arteriovenous malformation (AVM). At his first visit to the emergency room of the Internal Medicine Department at our hospital, he complained of vertigo and transitory tinnitus, but he did not show any obvious cranial nerve symptoms.
He was therefore diagnosed as having peripheral vertigo and treated with anti-motion sickness and antiemetic medicine. He came again the next day and was treated with fluid replacement and advised to consult the Department of Otolaryngology. Two days after the first visit, he consulted our otolaryngology outpatient clinic.
He presented with rightward gaze and positional nystagmus, dysarthria, curtain sign, and pooling of saliva at the piriform recess. We consulted the Department of Neurosurgery, suspecting a central nervous system disorder. CT and MRI scans revealed a 4-cm cerebellar hemorrhage and a compressed third ventricle. Cerebral angiography revealed a 1-cm AVM in the cerebellum. Subsequently, resection of the AVM was performed.
Twenty-six days after the first visit, although he still presented with rightward positional nystagmus, there was no gaze nystagmus and his caloric test was normal. Three months after the first visit, he presented with no positional nystagmus, but saccadic pursuit remained.
Although cerebellar hemorrhage commonly presents with vertigo, vomiting, headache, and appendicular ataxia as the first symptoms, we experienced a case of cerebellar hemorrhage from an AVM without such symptoms but with vertigo and tinnitus.
